"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

September 26, 2017

While the UN Security Council issued a statement last week calling to end the violence against the Rohingya Muslim population of Northern Rakhine State, Myanmar, military forces were burning more villages. In 3 weeks, over 400 000 people (more than half of them children and 400 newborn babies) have made the perilous boat voyage to Bangladesh, fleeing a violent campaign of scorched homes, killings, rapes, and landmine injuries.

Although Nobel Laureate Aung San Suu Kyi finally broke her silence this week condemning all human rights violations in Rakhine, she fell short of criticising the notorious Tatmadaw national army, which has a gruesome record of human rights abuses and of acting in flagrant disregard for international law.

This is a population in extreme precariousness, and access to humanitarian aid on both sides of the border must be immediately prioritised.

Bangladesh must be supported to manage the major humanitarian catastrophe that is unfolding with risks of infectious disease outbreaks, lack of basic water and sanitation, and exploitation of the population, especially of women and children (around 1000 unaccompanied minors). The UK Department of International Development has just announced £25 million to aid the humanitarian effort.

Satellite images show that nearly a third of Rohingya villages in Northern Rakhine are now empty. Burnings continue, but aid agencies have no access. Chris Lewa of The Arakan Project, which focuses on local research and advocacy, told The Lancet that even the 120 000 internally displaced persons camps in Southern Rakhine have had severe restrictions to food and medical aid.

A steering committee has been established to oversee the recommendations of the Kofi Annan-led Rakhine Advisory Commission on the long-term human rights, security, and development crisis, including interventions for Rakhine Buddhists whose perceived social neglect by NGOs has fuelled local intercommunal tensions.

In a Comment, Chris Beyrer asks if, in 2017, this is ethnic cleansing of the estimated 1·1 million stateless Rohingya in Rakhine. Forgotten by the world many times over, all diplomatic, legal, and humanitarian means must now be urgently deployed to protect the very existence of a ravaged Rohingya population.

Until resolution is reached, all parties to the fighting in Yemen must be repeatedly reminded to comply with international humanitarian law, taking constant care to spare civilians and civilian infrastructure. We implore all States with influence over the parties to exert greater pressure on fighting parties to respect and protect civilians.

Despite serious challenges, humanitarian agencies are having a tremendous impact. Millions of people in every governorate of Yemen receive humanitarian assistance every month through the Humanitarian Response Plan. Just last month, the World Food Programme delivered emergency food assistance to a record 7 million people across the country, helping to avert potential famine. This is an increase of some 60 per cent from the average 4.4 million people who received food assistance in the first six months of the year.

Partners in all sectors have been working tirelessly to prevent famine, contain the cholera outbreak, and assist the most vulnerable wherever we find them. This work is making an enormous difference.

But we could do so much more given the access and resources we need. Donors have been generous, particularly in funding the cholera response. Thank you. But this year’s humanitarian response plan is just 45 per cent funded, which means short-changing famine prevention efforts, and discontinuing programmes. WFP did reach 7 million people last month – but this came at the cost of cutting rations for about half of recipients to 60 per cent of the normal level.

Too many partners are facing similar, nearly impossible choices due to insufficient funding. I call on donors to provide full funding for the Humanitarian Response Plan, and note that the Yemen Humanitarian Fund is one of the quickest and most effective ways to support the most urgent priorities.

Other obstacles go beyond funding.

Too often, de facto authorities in Sana’a delay or block humanitarian assistance or the movements of humanitarian staff – including for the cholera response. This is despite a clear obligation under international law to allow unimpeded passage for humanitarian relief. These impediments are unacceptable.

Yemen imports more than 90 per cent of its staple food and nearly all its fuel and medicine. However, fluctuating restrictions on commercial imports are reducing availability of these commodities. All ports in Yemen must remain open to humanitarian and commercial traffic.

I welcome news that food availability rose in August, partially as a result of much higher imports in July. I urge Member States to do everything they can to sustain this trend – including by ensuring that vessels cleared by the UN Verification and Inspection Mechanism can proceed directly to port, and by deploying mobile cranes generously purchased by the US Government to relieve congestion at Hudaydah port.

The closure of Sana’a airport to commercial traffic has blocked thousands of Yemenis from travelling abroad for medical care, and restricted imports of some medical supplies. A resumption of commercial flights is needed immediately, especially for humanitarian cases.

Finally, we need to enable Yemen’s own health workers, teachers and water and sanitation staff to do their jobs. Salary arrears since October 2016 are accelerating the collapse of essential services. We seek your support in finding a way to ensure some 1.2 million public employees’ salaries are paid.

Overcoming each of these obstacles is within the reach of the international community. I look forward to working with you to achieve this life-saving agenda.

The Houthi rebels are in control of Sana'a and much of western Yemen, so they're at fault for closing the airport and blocking humanitarian assistance. Yemen's ports are closed to imports of food and medicine because of the Saudi-coalition naval blockade. But OCHA is much too polite to name and shame either party.

September 22, 2017

Kutupalong, Bangladesh – A massive scale-up of humanitarian aid in Bangladesh is needed to avoid a huge public health disaster following the arrival of hundreds of thousands of Rohingya refugees.

After a wave of targeted violence against the Rohingya, more than 422,000 people fled to Bangladesh from Rakhine State in Myanmar within three weeks. The most recent influx of Rohingya refugees has added to the hundreds of thousands of Rohingya who fled across the border during episodes of violence in previous years.

Most of the newly arrived refugees have moved into makeshift settlements without adequate access to shelter, food, clean water, or latrines. Two of the main pre-existing settlements in Kutupalong and Balukhali have effectively merged into one densely populated mega-settlement of nearly 500,000 people, making it one of the largest refugee concentrations in the world.

“These settlements are essentially rural slums that have been built on the side of the only two-lane road that runs through this part of the district,” says Kate White, MSF’s emergency medical coordinator. “There are no roads in or out of the settlement, making aid delivery very difficult. The terrain is hilly and prone to landslides, and there is a complete absence of latrines. When you walk through the settlement, you have to wade through streams of dirty water and human faeces.”

With little potable water available, people are drinking water collected from paddy fields, puddles, or hand-dug shallow wells which are often contaminated with excreta. At MSF’s medical facility in Kutupalong, 487 patients were treated for diarrhoeal diseases between 6 and 17 September.

“We are receiving adults every day on the cusp of dying from dehydration,” says White. “That’s very rare among adults, and signals that a public health emergency could be just around the corner.”

Food security in and around the settlements is incredibly fragile: newly arrived refugees are completely reliant on humanitarian aid; food prices in the market are skyrocketing; and the lack of roads is compromising access to the most vulnerable populations.

“With very little money and chaotic, congested and insufficient food distributions, many Rohingya people are only eating one meal of plain rice per day,” says White. “Some refugees told us that after days without food all they had eaten was one bowl of rice they received from a Bangladeshi restaurant owner, shared among a family of six.”

Meanwhile, medical facilities, including MSF’s own clinics, are completely overwhelmed. Between 25 August and 17 September, MSF clinics received a total of 9,602 outpatients, 3,344 emergency room patients, 427 inpatients, 225 patients with violence-related injuries, and 23 cases of sexual violence.

There is a very high risk of an infectious disease outbreak in the area given the huge and rapid increase in the population, as well as the low vaccination coverage among the Rohingya community in Myanmar.

Comprehensive vaccination campaigns for measles and cholera need to be launched immediately to reduce the outbreak risk and protect the Rohingya and Bangladeshi populations. In anticipation, MSF has prepared an isolation unit in the Kutupalong medical facility to rapidly contain any suspected or identified cholera or measles cases.

International humanitarian organisations must immediately be granted independent and unfettered access, including for international staff, to alleviate massive humanitarian needs in Rakhine State, Myanmar.

MSF’s call for urgent access comes amid the ongoing military operations in Rakhine, which started on 25 August after a new spate of attacks against police stations and a military base claimed by the Arakan Rohingya Salvation Army (ARSA). As a consequence, more than 400,000 Rohingya have fled to Bangladesh and are living in extremely precarious conditions with limited access to health care, drinking water, latrines and food.

The remaining population in Northern Rakhine, thought to be hundreds of thousands of people, is without any meaningful form of humanitarian assistance.

“Our teams in Bangladesh are hearing alarming stories of severe violence against civilians in Northern Rakhine,” says Karline Kleijer, MSF emergency desk manager. “Reports says there is significant internal displacement of Rohingya, ethnic Rakhine populations and other minorities. Villages and houses have been burned down, including at least two out of four of MSF’s clinics.”

“MSF was providing healthcare services in Maungdaw and Buthidaung townships in Northern Rakhine before they were put on hold due to a lack of travel authorisation and a ban on international staff in mid-August”, Ms Kleijer said. “We fear that the people remaining there are unable to access the help they may need. Injured, sick or chronically ill people in Northern Rakhine must be accessed without further delay, while emergency healthcare and other humanitarian assistance should be provided.”

In Central Rakhine, approximately 120,000 internally displaced people remain in camps where they are entirely dependent on humanitarian assistance for their survival, due to severe movement restrictions. MSF used to provide mobile clinics in several camps and villages for displaced people, but international staff have not been granted travel authorisations to visit the health facilities since August, whilst national staff have been too afraid to go to work following remarks by Myanmar officials accusing NGOs of colluding with ARSA.

The government-formulated and disseminated accusations against the UN and international NGOs, denial of required travel and activity authorisations, and threatening statements and actions by hardline groups, are all preventing independent humanitarian workers from providing much-needed assistance. Moreover Northern Rakhine has been declared a military zone by the government of Myanmar, resulting in even more severe administrative and access constraints.

The government of Myanmar says it wants to exclusively implement the humanitarian response to those affected in Rakhine, sparking fears that aid might not reach those who most need it.

September 16, 2017

Four years after then-President Barack Obama responded to the shooting deaths of 20 children and 6 adults at Sandy Hook Elementary School in Newtown, Connecticut, by ordering U.S. health agencies to sponsor gun research, the National Institutes of Health (NIH) has let lapse a funding program probing firearm violence and how to prevent it, Science has learned.

Renewal of the program, which has funded 22 projects for $18 million over the past 3 years, "is still under consideration" a NIH spokesperson said on 6 September, although the agency stopped accepting proposals in January and the last new awards are now being launched.

NIH told Science that scientists may still apply to do firearm research outside the program. Gun researchers say that's not enough, noting that thematic funding programs signal NIH priorities to scientists. They can also help tilt grant decisions toward those in the highlighted area over others that are equally good, but outside it. "It's really critically important to renew that program if we want more firearms research," says Rina Das Eiden, a developmental psychologist at the State University of New York in Buffalo.

Das Eiden and several collaborators won an award to study whether violence exposure and substance use raise the odds of gun violence in high-risk adolescents. "It would have been much harder for us to get funding for this research without that specific program announcement on firearm violence," she says.

The funding stream "was mission critical to bringing me into a new area," adds clinical psychologist Rinad Beidas of the University of Pennsylvania. Beidas won a grant to study how to implement gun safety counseling by pediatric primary care physicians to prevent youth suicide.

A prominent gun rights advocacy group says the program is redundant, however, and charges that it is driven by an antigun animus. "Private groups and foundations donate millions of dollars to fund firearm research every year," says Lars Dalseide, a spokesperson for the National Rifle Association's Institute for Legislative Action in Fairfax, Virginia. "When the government gets involved, and political agendas are allowed to supersede scientific analysis, the end product is nothing but a waste of tax-payer money."

Congress has long prohibited the U.S. Centers for Disease Control and Prevention from using government money "to advocate or promote gun control," and in 2012 extended that restriction to other agencies in the Department of Health and Human Services.

Obama argued, however, that research was not advocacy, and in response to his directive, NIH issued three funding opportunities for "Research on the Health Determinants and Consequences of Violence and its Prevention, Particularly Firearm Violence." The application window would close in January 2017, the agency noted.

After steadily declining for over a decade, global hunger is on the rise again, affecting 815 million people in 2016, or 11 per cent of the global population, says a new edition of the annual United Nations report on world food security and nutrition released today. At the same time, multiple forms of malnutrition are threatening the health of millions worldwide.

Some 155 million children aged under five are stunted (too short for their age), the report says, while 52 million suffer from wasting, meaning their weight is too low for their height. An estimated 41 million children are now overweight. Anaemia among women and adult obesity are also cause for concern. These trends are a consequence not only of conflict and climate change but also of sweeping changes in dietary habits as well as economic slowdowns.

The report is the first UN global assessment on food security and nutrition to be released following the adoption of the 2030 Agenda for Sustainable Development, which aims to end hunger and all forms of malnutrition by 2030 as a top international policy priority.

It singles out conflict – increasingly compounded by climate change – as one of the key drivers behind the resurgence of hunger and many forms of malnutrition.

"Over the past decade, conflicts have risen dramatically in number and become more complex and intractable in nature," the heads of the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the United Nations Children’s Fund (UNICEF) the World Food Programme (WFP) and the World Health Organization (WHO) said in their joint foreword to the report. They stressed that some of the highest proportions of food-insecure and malnourished children in the world are now concentrated in conflict zones.

"This has set off alarm bells we cannot afford to ignore: we will not end hunger and all forms of malnutrition by 2030 unless we address all the factors that undermine food security and nutrition. Securing peaceful and inclusive societies is a necessary condition to that end," they said.

Famine struck in parts of South Sudan for several months in early 2017, and there is a high risk that it could reoccur there as well as appear in other conflict-affected places, namely northeast Nigeria, Somalia and Yemen, they noted.

But even in regions that are more peaceful droughts or floods linked in part to the El Niño weather phenomenon, as well as the global economic slowdown, have also seen food security and nutrition deteriorate, they added.

Key numbers

Hunger and food security

• Overall number of hungry people in the world: 815 million, including:

• In Asia: 520 million

• In Africa: 243 million

• In Latin America and the Caribbean: 42 million

• Share of the global population who are hungry: 11%

• Asia: 11.7%

• Africa: 20% (in eastern Africa, 33.9%)

• Latin America and the Caribbean: 6.6%

Malnutrition in all its forms

• Number of children under 5 years of age who suffer from stunted growth (height too low for their age): 155 million

• Number of those living in countries affected by varying levels of conflict: 122 million

• Children under 5 affected by wasting (weight too low given their height): 52 million

• Number of adults who are obese: 641 million (13% of all adults on the planet)

• Children under 5 who are overweight: 41 million

• Number of women of reproductive age affected by anaemia: 613 million (around 33% of the total)

The impact of conflict

• Number of the 815 million hungry people on the planet who live in countries affected by conflict: 489 million

• The prevalence of hunger in countries affected by conflict is 1.4 - 4.4 percentage points higher than in other countries

• In conflict settings compounded by conditions of institutional and environmental fragility, the prevalence is 11 and 18 percentage points higher

• People living in countries affected by protracted crises are nearly 2.5 times more likely to be undernourished than people elsewhere

September 12, 2017

MAIDUGURI, Sept 12 (Reuters) - Efforts to contain a cholera outbreak that has struck more than 1,000 people in refugee camps in northeast Nigeria are being hampered because people are failing to report suspected cases to authorities, a United Nations official said.

Health officials in Borno, the northeastern state at the epicentre of both an insurgency by Islamist militant group Boko Haram and the disease outbreak, said the number of suspected cholera cases had jumped to 1,626 as of Sept. 11.

Forty people had died, it said, up from the 23 reported by the U.N. on Sept. 6.

Around 1.8 million have fled their homes because of violence or food shortages, U.N. agencies say. The rainy season has spread disease in densely populated camps where many people live in unsanitary conditions.

Most cholera-related deaths have been recorded at the Muna Garage camp, on the outskirts of Borno state capital Maiduguri.

Speaking from the camp, Souleymane Sow - a United Nations Children Fund (UNICEF) coordinator - said the "main problem" in containing the outbreak was a lack of referrals.

"When the people are sick they don't proactively report to the clinics," he said, adding that aid workers were conducting visits to homes in the camps to bring sick people to a treatment centre.

September 06, 2017

YANGON/SHAMLAPUR, Bangladesh, Sept 6 (Reuters) - Nearly 150,000 Rohingya Muslims have fled Myanmar for Bangladesh in less than two weeks, officials said on Wednesday after the United Nations chief warned there is a risk of ethnic cleansing in the former Burma that could destabilise the wider region.

Myanmar leader Aung San Suu Kyi blamed "terrorists" for "a huge iceberg of misinformation" on the violence in Rakhine state but she made no mention of the exodus of Rohingya since violence broke out there on Aug. 25.

She has come under increasing pressure from countries with Muslim populations, including Indonesia, where thousands led by Islamist groups held a rally in Jakarta on Wednesday, to demand that diplomatic ties with Buddhist-majority Myanmar be cut.

In a rare letter to the U.N. Security Council on Tuesday, Secretary-General Antonio Guterres expressed concern that the violence in Rakhine could spiral into a "humanitarian catastrophe".

Reuters reporters in the impoverished Cox's Bazar region of neighbouring Bangladesh have witnessed boatloads of exhausted Rohingya arriving near the border village of Shamlapur.

According to the latest estimates issued by U.N. workers operating in Cox's Bazar, arrivals in just 12 days stood at 146,000. This brought to 233,000 the total number of Rohingya who have sought refuge in Bangladesh since last October.

Newly arrived Rohingyas told authorities that three boats carrying between them more than 100 people capsized in the early hours of Wednesday. Coast guard Commander M.S. Kabir said six bodies, including three children, had since washed ashore.

August 21, 2017

Violence, preventable diseases and traffic accidents are to blame for a widening of the youth mortality gap between the developed and developing world, according to a new Guardian analysis of the most recent World Health Organisation (WHO) data.

The most dangerous country in the world to be a young person (defined as aged between 15 and 29) is Sierra Leone, with one youth in every 150 there estimated to have died in 2015. Its youth mortality rate per 100,000 (671) is almost 100 people higher than the next country on the list, war-torn Syria (579).

Cyprus is the safest of the 184 countries analysed, with a death rate of almost one in every 4,762 youths, while Denmark, the fifth safest, halved its number of young deaths between 2000 and 2015. The United Kingdom (one in every 3,030 young people) is ranked just outside the top 10 safest countries, behind Israel.

The analysis finds that young people in the United States are six times as likely to be murdered as their British counterparts. They are also more than three times as likely to be killed in a car crash, and twice as likely to commit suicide or overdose on drugs. Self-harm is the most common cause of death for young people in the UK.

Liberal drug policies in the Netherlands may be responsible for a rate of drug-related deaths almost exactly ten times lower than in the US.

Globally, the mortality rate for young people decreased 21% between 2000 and 2015, with HIV-related deaths in particular falling significantly. Yet the gap between developing and developed countries has widened in that period, from 2.2 up to 2.4 times higher.

The rest of the top 10: Syria, Ivory Coast, Central African Republic, Nigeria, Chad, Angola, South Sudan, Mozambique, and Somalia. Every one of them did time as a European colony. Read the whole article and you'll see the rest of the post-colonial world hasn't done that much better.

No wonder so many young men and women become migrants and refugees: they're running for their lives.

August 13, 2017

• Over 494,000 suspected cholera cases and 1,966 deaths were reported in under four months.

• Two million Yemenis are displaced; one million have returned to their homes.

• In two separate incidents, 280 migrants were forced off boats near the Yemeni coast, killing scores of them.

• An airstrike in Sa’ada killed 12 people, including women and children, on 4 August.

Cholera crisis far from over

Over 494,000 suspected cases and 1,966 deaths in less than four months The cholera outbreak in Yemen has claimed some 1,966 lives in less than four months and more than 5,000 people are falling ill every day with symptoms of acute watery diarrhoea/cholera. All governorates have been affected, except Socotra. Children and the elderly are the hardest hit: more than 41 per cent of the suspected cases since 27 April and a quarter of the deaths are children, while people over 60 represent 30 per cent of fatalities.

The outbreak is man-made; more than two years of conflict have severely degraded sanitation systems, health services and other public institutions. More than half of all health facilities have closed or are only partially functional, leaving 14.8 million people without adequate access to healthcare.

Some 15.7 million people can no longer access clean water and sanitation because infrastructure is disrupted or damaged. Thirty thousand health workers have been paid erratically or not at all for almost a year, which has greatly affected services through absenteeism and reduced commitment.

The outbreak is currently the worst in the world. It has significantly worsened what was already one of the world’s largest humanitarian crisis: more than 60 per cent of the population are facing the threat of food insecurity, seven million people are severely food insecure and two million children are acutely malnourished. Malnourished children, pregnant women and people living with other chronic health conditions are at greater risk of death as they face the “triple threat” of conflict, famine and cholera.